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Non-traumatic Spontaneous Heterotopic Ossification Causing Elbow Ankylosis in a Pediatric Hemophiliac: A Case Report on Management in Low-Resource Settings

Home Non-traumatic Spontaneous Heterotopic Ossification Causing Elbow Ankylosis in a Pediatric Hemophiliac: A Case Report on Management in Low-Resource Settings

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Abstract

Introduction

Heterotopic ossification (HO), soft-tissue ossification due to muscle trauma, is fairly common in individuals with hemophilia, but uncommon in the pediatric age group. Bridging ankylosis is even rarer.

Case Presentation

We report the case of an 11-year-old boy with moderate hemophilia A who presented with atraumatic complete left elbow ankylosis, following complaints of spontaneous swelling and stiffness and two instances of massaging and bandaging over a 4-year period. Radiography was suggestive of heterotopic ossification forming a bony bar, or bridge, and surgical excision was performed with recombinant factor 7 and Emicizumab coverage. Histopathology confirmed the diagnosis, and physiotherapy ensured reasonable functional recovery in the immediate postoperative period and the first week. The patient developed a hematoma on the seventh postoperative day, extending from the suture site to the periosteum in the intermuscular plane. Alterations to his postoperative regimen and careful monitoring ensured hematoma resolution.

Conclusions

HO is underreported, and it is unsurprising that there is also little literature on evidence-based guidelines for surgical excision and managing potential hematomas. This paper aims to highlight a case of clinical interest with bridging ankylosis and no history of trauma and consolidate insights from existing literature on diagnosis, management, and the pitfalls of attempting surgical repair in low-resource settings with poor patient compliance. We focus on post-operative complications affecting functionality and potential recurrence in such environments.

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Funding

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Author information

Authors and Affiliations

  1. Osmania General Hospital/Medical College, Turrebaz Khan Rd, Troop Bazaar, 500095, Hyderabad, Telangana, India

    Manasi Narreddy

  2. Department of Orthopedics and Traumatology, Osmania General Hospital/Medical College, Hyderabad, India

    Sanyam Rakheja

  3. Maharajah’s Institute of Medical Sciences, Vizianagaram, India

    Chandra Vamsee Gottumukkala

Contributions

M.N.: Writing—original draft preparation (lead); writing—review and editing (equal); conceptualization (equal); investigation and visualization (equal). S.R.: Supervision (lead); writing—review and editing (equal); conceptualization (equal); investigation and visualization (equal). C.G.: writing—review and editing (equal); conceptualization (equal).

All authors read and approved the final manuscript.

Corresponding author

Correspondence to Manasi Narreddy.

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Ethics Approval

IRB not applicable.

Consent to Participate

Informed written consent from the patient and their parents regarding the disclosure of clinical information, radiographic, intraoperative, and postoperative images and videos was taken. Care has been taken to not reveal the patient’s personal information. The patient and their parents were given an opportunity to review the manuscript and consented to its publication.

Conflict of Interest

IRB not applicable.

Additional information

Supplementary Information

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Cite this article

Narreddy, M., Rakheja, S. & Gottumukkala, C.V. Non-traumatic Spontaneous Heterotopic Ossification Causing Elbow Ankylosis in a Pediatric Hemophiliac: A Case Report on Management in Low-Resource Settings. SN Compr. Clin. Med. 7, 216 (2025). https://doi.org/10.1007/s42399-025-01980-7

  • Received
  • Revised
  • Accepted
  • Published
  • DOI https://doi.org/10.1007/s42399-025-01980-7

Keywords

  • Ankylosis/radiography
  • Case reports
  • Hemophilia A
  • Ossification
  • Heterotopic
  • Myositis Ossificans/complications
  • Bony bar/radiography

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